On July 4, 2025, President Trump signed into law the One Big Beautiful Bill Act (H.R. 1), which overhauls Medicaid, Medicare, ACA marketplace rules, CHIP, and related programs (Crowell & Moring LLP, 2025).
Starting immediately and through 2027–2028, it introduces sweeping eligibility restrictions and funding reductions. Key provisions include:
- Medicaid faces $900 billion to $1.2 trillion in cuts over 10 years. These cuts involve stricter work or volunteer requirements (80 hours/month) for most adults aged 19–64, new cost-sharing of up to $35 per service, more frequent eligibility renewals (every six months), and restrictions on provider taxes states can use to support Medicaid funding (ValuePenguin, 2025).
- Retroactive coverage is shortened: after January 1, 2027, traditional Medicaid retro-coverage drops to one month (two months only for non-expansion adults), raising the risk of unpaid costs for seniors and people needing nursing-home care (MarketWatch, 2025).
- Medicare is less directly cut, but automatic PAYGO sequestration may trigger up to 4% cuts in future annual Medicare payments beginning as early as 2026. Immigration-based eligibility for some non-citizen seniors is also restricted starting in 18 months (Health Industry Washington Watch, 2025).
Who is affected?
Medicaid expansion adults, including childless adults, face new costs and reporting burdens that may push many off coverage.
Low-income seniors and people with disabilities—even those dually enrolled in Medicare and Medicaid—will face more red tape and reduced access to long-term services and home-and-community-based supports (HCBS) under tightened eligibility rules (Justice in Aging, 2025).
Immigrants, including refugees, asylum seekers, and some with temporary protected status, will lose Medicaid and Medicare eligibility entirely after specified delays (Association of State and Territorial Health Officials, 2025).
Rural hospitals and safety-net providers are vulnerable, as they rely on Medicaid supplemental payments and provider taxes that will now be capped or reduced (Human Medical Billing, 2025).
Estimates suggest 10–17 million more Americans could become uninsured by 2034 due to this bill, resulting in increased medical debt, delayed care, and worse health outcomes, particularly in rural and vulnerable communities (Associated Press, 2025).
How These Changes Affect People Seeking Disability Ramps
Many people rely on Medicaid to cover home modifications such as ramps as part of HCBS or State Medicaid Waiver programs. With eligibility tightening, increased cost-sharing, and reduced home-and-community support funding, fewer individuals may qualify for or be able to access ramp funding directly through Medicaid.
Similarly, Medicare rarely covers home modifications, and those who previously qualified for supplemental Medicaid-based support may lose access entirely if they fall off Medicaid.
- Reduced HCBS budgets in states lead to longer waitlists or denial of funding for modifications like wheelchair ramps.
- Cost-sharing and work requirements may make previously eligible individuals unable or unwilling to maintain coverage.
- Providers are shifting resources to core medical services, deprioritizing home modifications.
Other Sources of Funding for Wheelchair Ramps Beyond Medicaid & Medicare
For individuals who no longer qualify, or who face delays/ineligibility, there are a few alternative options. You can visit our financing guide to learn more about each of these, but the below outlines some of the potential funding sources for mobility ramps aside from Medicare and Medicaid:
- Veterans’ Benefits (if applicable)
- State Vocational Rehabilitation and Independent Living Programs
- Nonprofit Organizations
- Local Government Programs
- Private Funding & Crowdfunding
- Low-Interest Loans or Financing Programs
- Insurance Coverage
- Workforce Accommodation Funds
- Advice and Resources from Amramp Accessibility
At Amramp, we understand how essential safe, reliable access ramps are—whether for homes, workplaces, or public facilities. With Medicaid becoming less accessible for many due to new funding limits, more people find themselves in need of other support routes.
Here’s what we recommend:
Check your Medicaid status now: if you’re at risk of losing eligibility, explore applying before rules take full effect (retroactive coverage changes begin January 2027).
Contact your state’s Independent Living Center or Consumer Directed Personal Assistance Program (CDPAP). These often operate under separate state waivers and may still fund ramps.
Take advantage of V.A. benefits if eligible.
Apply for nonprofit or local government home modification grants or loans.
Consider medical tax deductions—if you itemize and qualify, you may write off part of the cost.
Crowdfund or seek community support, especially when timelines or documentation challenges may delay state assistance.
Speak with your physician or occupational therapist to document medical necessity, which strengthens eligibility or allowances through alternate funding sources.
Final Thoughts
The One Big Beautiful Bill Act, now law as of July 4, 2025, marks one of the most sweeping transformations to Medicaid and Medicare eligibility, cost-sharing, and funding in decades. These changes—rolling out through 2026–2028—will tighten access to home-based supports, potentially limiting coverage for essential mobility aids like ramps (Justice in Aging, 2025; JD Supra, 2025; Associated Press, 2025; MarketWatch, 2025).
If you or a loved one depend on Medicaid for a ramp or accessible modifications and face new restrictions, exploring alternative funding sources is more important than ever. At Amramp, we are here to help people remain independent and secure safe access, whether through insurance, public programs, nonprofits, or creative solutions.
Explore our financing guide for direction on navigating these funding changes and finding the best route for your accessibility needs.
This post is intended to inform, not offer legal or tax advice. Policies vary by state and individual circumstance. Always consult relevant professional resources for guidance.
